Provider Demographics
NPI:1518907161
Name:AGRE, JAMES COURTLAND (MD)
Entity Type:Individual
Prefix:PROF
First Name:JAMES
Middle Name:COURTLAND
Last Name:AGRE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 297
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-2661
Mailing Address - Fax:612-624-6686
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 297
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-625-2661
Practice Address - Fax:612-624-6686
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-02-04
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Provider Licenses
StateLicense IDTaxonomies
MN239482081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D33970Medicare UPIN